Active NPI
Andrew Craig Jackson, CRNA
- Certified Registered Nurse Anesthetist
- Jefferson, NC
National Provider Identifier
1174516132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 085415
- Practice address
- 200 Hospital Ave
Jefferson, NC 28640-9244 - Phone
- (336) 846-0719
- NPI assigned
- Aug 25, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 085415 | NC | Primary |
Addresses
Primary practice location
200 Hospital Ave
Jefferson, NC 28640-9244
Mailing address
244 Falls Creek Rd
Todd, NC 28684-9219
Phone (336) 877-2047
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8049903 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085415 | NC | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225152000000",
"number": "1174516132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "244 FALLS CREEK RD",
"city": "TODD",
"state": "NC",
"postal_code": "286849219",
"telephone_number": "336-877-2047",
"fax_number": "336-877-5545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 HOSPITAL AVE",
"city": "JEFFERSON",
"state": "NC",
"postal_code": "286409244",
"telephone_number": "336-846-0719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ANDREW",
"middle_name": "CRAIG",
"name_prefix": "Mr.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-25",
"last_updated": "2008-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "NC",
"license": "085415",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8049903",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jefferson, NC
- Colinda Anderson Hendricks, M.A.
- Gregory S Hershner, MD
- High Country Family Medicine, PA
- Christina Marie Howell, LPCA
- Donald K Huffman, DO
- Jefferson Care Center
- Jefferson Emergency Services, PLLC
- Jeffrey K. Baldwin (Baldwin Chiropractic Center)
- Jodi Province Counseling Services PLLC
- Joel W. Yates Jr. D.D.S. P.L.L.C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.